As a young doctor 20 years ago, she saw an otherwise healthy 36-year-old woman die from complications of influenza. That memory has remained with the Albany Medical Center physician, who each year admits patients to the hospital with seasonal flu.

Trouble is, she said, lots of patients refuse the vaccine — no matter that she tells them the flu can be dangerous and the vaccine is safe. On Tuesday morning, she urged three patients who haven't received their shot to get it. Two said no.

"The fear of the disease does not outweigh the fear of the vaccine," Higgins said.

Statewide, 47 percent of New Yorkers get the flu vaccine.

That rate provided one of the low points in a report released Tuesday, in which New York mostly scored well on measures of its ability to protect residents against microscopic organisms. The report, "Outbreaks: Protecting Americans from Infectious Diseases," was produced by the Trust for America's Health and Robert Wood Johnson Foundation.

New York scored 7 out of 10 for such practices as mandating that hospitals report infection rates and having a public health lab that can handle a sudden surge in testing. Most states — 34 — scored 5 or less.

But in dealing with the perennial problem of seasonal flu, New York fell short of the 50 percent vaccination rate the report's authors set as a benchmark. So did 38 other states.

"Clearly, when only 12 states reached that 50 percent threshold, we have a lot more to do in that area," said TFAH Executive Director Jeff Levi.

According to state data reported to the U.S. Centers for Disease Control and Prevention, the vaccination rate is higher among certain age groups. Among children 6 months to 4 years old, the vaccination rate is 70 percent. It's 68 percent for seniors, ages 65 and older.

Among those age 18 to 49 years old, however, the rate is 32 percent.

Local doctors said getting more people vaccinated is not a matter of better education or promotion; there's enough of that. There's also no shortage of vaccine. Myths about the dangers of the vaccine need to be busted, they said. And a faulty mind-set among healthy people who believe they are immune to the flu must be broken.

Dorah Bluth, a 57-year-old Slingerlands resident, got her flu shot this year, as she does annually. But she had to nag her three adult children to get vaccinated, she said. The repeated encouragement worked on two of them.

"I do not think my 30-year-old daughter got one," Bluth said. "She is still in the 'I'm invincible' stage of life.' "

Patients' false perceptions include that they are likely to have a bad reaction to preservatives in the vaccine, or that a shot will give them a case of the flu, said Dr. Dan Silverman, chief medical officer at Samaritan and St. Mary's hospitals in Troy. In reality, the vaccine has repeatedly been proven safe, and even minor side effects are rare, he said. The most common reactions are soreness at the shot site, low fever or achiness, according to the CDC.

Far worse than minor reactions to the vaccine are the potential consequences of the flu itself, doctors said. While people commonly refer to all manner of winter illness as "the flu," the fever, body aches and breathing trouble are more intense with a true case of influenza. Some patients develop severe respiratory infections, including pneumonia, and don't recover.

Smokers and asthmatics are often easy to motivate to get vaccinated, because they know they're at risk for such infections, Higgins said. Seniors are more likely to get vaccinated, because they know their immune systems are less able to fight potential complications from the illness. Parents get shots or nasal spray for their young children, who are at risk for complications because their immune systems are not fully developed.

It's the relatively healthy people who are caught off-guard when they catch the flu, Higgins said.

"It's the middle-age male who's a little overweight who says, 'I'm fine' — they're the ones who get sick and die," she said.

In its most recent weekly report, the state Health Department deemed flu to be "local" — worse than "sporadic" but not yet "widespread" — with 189 laboratory-confirmed cases, an increase of 133 percent from the previous week. And local doctors said the pace is picking up as flu season, roughly October through March, continues.

The good news, as Silverman reminded, is that it's not too late to get the vaccine. And the strains of flu in the vaccine this year match those that are spreading, so it's highly effective, Higgins added.